Comprehensive weight management as a key factor in improving the effectiveness of endometrial cancer therapy with fertility preservation

Endometrial cancer is a prevalent oncological disease closely linked to obesity and disturbances in carbohydrate and lipid metabolism. Current approaches to conservative treatment of endometrial cancer in young women aim to preserve reproductive function and include high-dose progestin therapy, which may further contribute to weight gain. The relationship between obesity and treatment efficacy in endometrial cancer is multifactorial and involves hormonal changes, chronic inflammation, metabolic disturbances, and alterations in the tumor immune microenvironment. A comprehensive weight management approach—including dietary interventions (such as ketogenic diet, intermittent fasting, and caloric restriction), regular physical activity, and behavioral therapy—has demonstrated significant improvements in tumor remission rates and pregnancy achievement. This review highlights the key mechanisms by which obesity contributes to the development and progression of endometrial cancer, discusses current weight management strategies, and outlines future research directions, including the study of metabolites, the gut microbiome, neural appetite regulation mechanisms, and the implementation of personalized approaches using artificial intelligence and wearable devices. Comprehensive weight management is becoming a priority area for improving treatment effectiveness and outcomes in patients with endometrial cancer who aim to preserve their reproductive function.